Delta Dental is one of the largest dental insurance providers in the United States, offering various dental plans for individuals and families. Many people are curious about whether Delta Dental covers braces for adults, as orthodontic treatments are often thought of as being for children or teenagers. However, adults can benefit from braces too, whether for cosmetic reasons or to improve oral health. This article will explore whether Delta Dental covers braces for adults, the types of braces it might cover, the criteria for coverage, and how to make the most of your dental plan if you’re considering braces.
Understanding Delta Dental Insurance
Delta Dental offers several different plans, and each plan may have different levels of coverage. The plans typically include preventative care, such as cleanings and exams, as well as restorative treatments like fillings, crowns, and bridges. However, orthodontic treatments, including braces, may not always be included in every plan. It is important to understand the specifics of your Delta Dental plan and what it covers.
Types of Delta Dental Plans
Delta Dental provides both individual and family plans. There are two main types of plans that may include orthodontic coverage:
Delta Dental PPO (Preferred Provider Organization) Plans: These plans offer more flexibility in choosing dentists, but there may be higher out-of-pocket costs if you go outside of the network. Orthodontic coverage may be included, but it depends on the specific plan.
Delta Dental HMO (Health Maintenance Organization) Plans: These plans require you to choose a primary care dentist. Coverage for braces may be more limited under these plans, but there may still be options for adults.
It’s important to check your specific plan details to see whether orthodontic treatment is covered.
Does Delta Dental Cover Braces for Adults?
In general, Delta Dental insurance may cover braces for adults, but this coverage depends on the plan. Most standard Delta Dental plans do not cover braces for adults unless they are medically necessary. For example, if braces are required to correct severe misalignment or bite issues that affect your ability to chew or speak, Delta Dental may cover part of the treatment.
However, if the braces are being used for cosmetic purposes only (i.e., to straighten teeth for appearance rather than health reasons), coverage may be limited or excluded. You will need to review your specific plan details to find out the extent of coverage.
Medical Necessity for Braces
To qualify for coverage, braces typically need to be deemed “medically necessary.” This means that the braces are needed to treat a functional issue with your teeth, such as a severe overbite, underbite, or difficulty chewing. A dentist or orthodontist will need to provide documentation to Delta Dental to prove that the braces are medically necessary for your health and not just for cosmetic purposes.
If braces are not medically necessary, they may not be covered. However, some Delta Dental plans offer orthodontic coverage for adults under certain circumstances. For instance, if the treatment plan involves correcting misalignment that causes difficulty with chewing or talking, Delta Dental may provide partial coverage.
What Types of Braces Does Delta Dental Cover?
Delta Dental may cover various types of braces, depending on your plan. The most common types of braces include:
Traditional Metal Braces: These are the most common and the least expensive type of braces. They are typically covered by insurance, provided they are deemed medically necessary.
Ceramic Braces: These braces are similar to metal braces but are less noticeable, as they are made from clear or tooth-colored materials. Ceramic braces may be covered under certain plans, but coverage may be limited or require additional costs.
Invisalign (Clear Aligners): Invisalign is a popular alternative to traditional braces. They are clear plastic aligners that gradually move the teeth into the correct position. Some Delta Dental plans may cover Invisalign, but it is usually only available if the treatment is deemed medically necessary.
Lingual Braces: These are similar to traditional metal braces but are placed on the inside of the teeth, making them less visible. Coverage for lingual braces may vary, and they may not be covered by all Delta Dental plans.
The availability of these treatments under your plan depends on the type of coverage you have and whether the orthodontic treatment is deemed medically necessary.
Factors That Affect Delta Dental’s Coverage for Braces
Several factors can impact whether your Delta Dental plan will cover braces for adults. Some of these factors include:
Age
While braces are typically associated with children and teenagers, adults can benefit from orthodontic treatment too. Some Delta Dental plans may have age restrictions or limits on how long you can receive orthodontic treatment under your plan. If you’re an adult, you may need to provide documentation of the medical need for the treatment.
Plan Type
As mentioned earlier, Delta Dental PPO plans tend to offer more flexibility in coverage, but you may still face higher out-of-pocket costs if you choose out-of-network providers. HMO plans may have stricter limitations on orthodontic coverage, and you may be required to receive treatment from an in-network provider.
Coverage Limits
Even if orthodontic treatment is covered by your Delta Dental plan, there may be limits on how much the plan will pay. Many plans only cover a portion of the treatment costs, and you may be responsible for paying the remaining balance. For example, Delta Dental may cover 50% of the cost of braces, and the rest may need to be paid out-of-pocket.
Waiting Periods
Some Delta Dental plans have waiting periods before orthodontic coverage begins. This means you may need to be enrolled in the plan for a certain period (often 12 to 24 months) before you are eligible for orthodontic coverage. Be sure to review your plan’s waiting period requirements.
How to Maximize Your Delta Dental Insurance for Braces
If you are considering braces as an adult and want to make the most of your Delta Dental insurance, here are some tips:
Check Your Coverage: Review your Delta Dental plan to determine what orthodontic services are covered. Look for any age restrictions, coverage limits, and requirements for medical necessity.
Consult with Your Dentist or Orthodontist: Your dentist or orthodontist can help determine whether braces are necessary for your oral health and can assist in submitting the required documentation to Delta Dental.
Consider Alternative Options: If your Delta Dental plan does not cover braces for adults, you may want to explore other options, such as payment plans, health savings accounts (HSAs), or flexible spending accounts (FSAs), to help manage the costs of braces.
Choose an In-Network Provider: To minimize out-of-pocket expenses, consider choosing an in-network orthodontist or dentist, as this will often result in lower fees and better coverage.
Ask About Discounts: Some orthodontists may offer discounts or financing options for adult braces, which can help make treatment more affordable.
Conclusion
Delta Dental insurance can cover braces for adults, but the coverage depends on the specifics of your plan. If braces are deemed medically necessary, there is a higher chance of coverage, but cosmetic treatments may not be covered. It’s essential to check your plan’s details, including any age restrictions, waiting periods, and coverage limits, before proceeding with treatment. By consulting with your dentist or orthodontist and exploring all available options, you can maximize your dental insurance benefits and achieve the smile you desire.
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